Yamada Yuji, Narita Zui, Inagawa Takuma, Yokoi Yuma, Hirabayashi Naotsugu, Shirama Aya, Sueyoshi Kazuki, Sumiyoshi Tomiki
Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
Front Psychiatry. 2023 Oct 4;14:1243859. doi: 10.3389/fpsyt.2023.1243859. eCollection 2023.
Patients with schizophrenia suffer from cognitive impairment that worsens real-world functional outcomes. We previously reported that multi-session transcranial direct current stimulation (tDCS) delivered to the left dorsolateral prefrontal cortex (DLPFC) improved daily living skills, while stimulation on the left superior temporal sulcus (STS) enhanced performance on a test of social cognition in these patients. To examine the region-dependent influence of tDCS on daily-living skills, neurocognition, and psychotic symptoms, this study compared effects of anodal stimulation targeting either of these two brain areas in patients with schizophrenia.
Data were collected from open-label, single-arm trials with anodal electrodes placed over the left DLPFC (N = 28) or STS (N = 15). Daily-living skills, neurocognition, and psychotic symptoms were measured with the UCSD performance-based skills assessment-brief (UPSA-B), Brief Assessment of Cognition in Schizophrenia (BACS), and Positive and Negative Syndrome Scale (PANSS), respectively. After baseline evaluation, tDCS (2 mA × 20 min) were delivered two times per day for 5 consecutive days. One month after the final stimulation, clinical assessments were repeated.
Performance on the UPSA-B was significantly improved in patients who received anodal tDCS at the left DLPFC ( = 0.70, < 0.001), while this effect was absent in patients with anodal electrodes placed on the left STS ( = 0.02, = 0.939). Significant improvement was also observed for scores on the BACS with anodal tDCS delivered to the DLPFC ( = 0.49, < 0.001); however, such neurocognitive enhancement was absent when the STS was stimulated ( = 0.05, = 0.646). Both methods of anodal stimulation showed a significant improvement of General Psychopathology scores on the PANSS (DLPFC, = 0.50, = 0.027; STS, = 0.44, = 0.001).
These results indicate the importance of selecting brain regions as a target for tDCS according to clinical features of individual patients. Anodal stimulation of the left DLPFC may be advantageous in improving higher level functional outcomes in patients with schizophrenia.
These studies were registered within the University hospital Medical Information Network Clinical Trials Registry [(24), UMIN000015953], and the Japan Registry of Clinical Trials [(28), jRCTs032180026].
精神分裂症患者存在认知障碍，这会使现实世界中的功能结局恶化。我们之前报道过，多次经颅直流电刺激（tDCS）作用于左侧背外侧前额叶皮质（DLPFC）可改善日常生活技能，而刺激左侧颞上沟（STS）可提高这些患者在社会认知测试中的表现。为了研究tDCS对日常生活技能、神经认知和精神症状的区域依赖性影响，本研究比较了针对这两个脑区之一进行阳极刺激对精神分裂症患者的效果。
数据收集自开放标签、单臂试验，阳极电极置于左侧DLPFC（N = 28）或STS（N = 15）上方。分别使用基于表现的加州大学圣地亚哥分校简短技能评估（UPSA - B）、精神分裂症认知简短评估（BACS）和阳性与阴性症状量表（PANSS）来测量日常生活技能、神经认知和精神症状。在基线评估后，tDCS（2 mA×20分钟）每天进行2次，连续进行5天。最后一次刺激后1个月，重复进行临床评估。
接受左侧DLPFC阳极tDCS的患者在UPSA - B上的表现有显著改善（ = 0.70， < 0.001），而左侧STS放置阳极电极的患者则没有这种效果（ = 0.02， = 0.939）。对接受DLPFC阳极tDCS的患者，BACS评分也有显著改善（ = 0.49， < 0.001）；然而，刺激STS时没有这种神经认知增强（ = 0.05， = 0.646）。两种阳极刺激方法均显示PANSS上的总体精神病理学评分有显著改善（DLPFC， = 0.50， = 0.027；STS， = 0.44， = 0.001）。
这些结果表明根据个体患者的临床特征选择脑区作为tDCS靶点的重要性。左侧DLPFC的阳极刺激可能有利于改善精神分裂症患者的高级功能结局。
这些研究已在大学医院医学信息网络临床试验注册中心[（24），UMIN000015953]和日本临床试验注册中心[（28），jRCTs032180026]注册。
